Outpatient Surgery Magazine - Subscribers

OR Excellence Awards - Outpatient Surgery Magazine - September 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 47 of 126

lower readmission rates. Texas Health Presbyterian Hospital in Dallas has earned the 2018 OR Excellence Award for Pain Control for using those abstract ideas to develop an opioid-sparing pain control pro- gram that has achieved some tangible — and impressive — results: • Patient-controlled analgesia pump use before implementation of the ERAS pathway was about 37%. By June of this year, zero ERAS patients received PCA pumps to manage their post-op pain. • During early implementation of the ERAS pathway, patients received just over 150 morphine equivalent dosing through post-op day 3. The ERAS program helped slash that amount in half. That reduction in morphine equivalent dosing is important because leadership at Presbyterian Hospital launched the program in 2016 dur- ing the nation's opioid crisis. That year, according to the U.S. Department of Health and Human Services, 116 Americans died every day from opioid-related overdoses and 11.5 million people nationwide misused prescription opioids. The opioid crisis was a major factor in the decision to launch the ERAS pathway, according to Nikita Preston, BSN, RN, nurse manager of the hospital's bariatric unit. "We want to get surgical patients into and out of the hospital with a reasonable amount of pain that they'd be able to manage at home," she says. Concerns about getting patients hooked on opioids is an important consideration, but the powerful painkillers can also cause a host of more common post-op complications — such as PONV, prolonged ileus and respiratory depression — that can slow recoveries. To limit the use of opioids, Presbyterian Hospital relies on a multi- modal pain management protocol that includes administering gabapentin and IV Tylenol before surgery. The protocol also involves the use of ketamine, dexmedetomidine, neuraxial anesthesia and transversus abdominis plane (TAP) blocks. Anesthesia providers 4 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 8

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